Provider perspective: What do clinicians and pharmacists think about over-the-counter provision of oral contraceptives?

A growing body of literature suggests that over-the-counter (OTC) provision of oral contraceptives (OCs) is safe and effective. Little research specifically addresses the perspective of providers. Clinicians may have concerns that their clients will not receive the necessary information and counseling to select an appropriate OC and use it correctly, and they may fear that women will not obtain needed preventive services like Pap smears and screening for sexually transmitted diseases. Evidence suggests that clinician counseling is of limited benefit at best. Data from settings where OCs are available de facto OTC, like Mexico, reveal that women frequently move between provision sources and consult with a clinician when they feel it necessary. Research also indicates that women do obtain preventive services even when they are not forced to see a clinician to obtain hormonal contraception. Clinic systems may also fear reductions in revenue if OCs are available OTC, which in turn may affect the other services they can offer. Some pharmacists, however, may be interested in assuming a new, more active role in contraceptive provision if OCs were available in a pharmacy without a prescription. Even before OCs become available OTC, clinicians could implement evidence-based practices such as Quickstart initiation and dispensing a year of pill packs at one time that could help to improve access to this highly effective contraceptive method. More research and better dissemination of existing evidence is needed to understand and address the concerns of clinicians and pharmacists related to an OTC switch for OCs.